EMPLOYEE ANNUAL UPDATE FORM

EMPLOYEE PARTICULARS (This form is to be completed by Employee)

Name MOHD HAFIZ BIN RAMLI ☒ Male ☐ Female Date of Birth: 18/2/1984
(as per IC / Passport)
IC / Passport No. 840218115655 Admin No. 7688 Contact No. 019-7897270
Address PT 15609 JALAN LAPANGAN TERBANG,KAMPUNG KOLAM 24300 KERTEH
TERENGGANU
Marital Status (tick accordingly) ☐ SINGLE ☒ MARRIED ☐ DIVORCED Marriage Date :
31/5/2012
SPOUSE PARTICULARS
Name NOOR HAKIMAH BT MOHD ☐ Male ☒ Female Date of Birth: 23/10/198
(as per IC / Passport) NOOR 5
IC / Passport No. 851023115288 Is Spouse Working? ☒ YES ☐ NO
Spouse Employer SK SERI GELUGOR Contact No. 013-9639160
CHILDREN PARTICULARS
No Name (as per IC / Passport / Birth Cert) Sex Date of birth Age IC / Passport / Birth Cert. No.
1. HANIM NUR IMAN BT MOHD ☐ Male 5 131117110298
HAFIZ ☐ Female 17/11/2013
If your child is 18 years old and above ☐ Diploma level and above, studying in Malaysia ☐ Please tick here
and still studying, please tick accordingly, if your child is
☐ Degree level and above, studying outside Malaysia disabled
No Name (as per IC / Passport / Birth Cert) Sex Date of birth Age IC / Passport / Birth Cert. No.
2. HADIF ANAQI BIN MOHD HAFIZ ☐ Male 3/6/2016 2 160603110173
☐ Female
If your child is 18 years old and above ☐ Diploma level and above, studying in Malaysia ☐ Please tick here
and still studying, please tick accordingly, if your child is
☐ Degree level and above, studying outside Malaysia disabled
No Name (as per IC / Passport / Birth Cert) Sex Date of birth Age IC / Passport / Birth Cert. No.
3. ☐ Male
☐ Female
If your child is 18 years old and above ☐ Diploma level and above, studying in Malaysia ☐ Please tick here
and still studying, please tick accordingly, if your child is
☐ Degree level and above, studying outside Malaysia disabled
No Name (as per IC / Passport / Birth Cert) Sex Date of birth Age IC / Passport / Birth Cert. No.
4. ☐ Male
☐ Female
If your child is 18 years old and above ☐ Diploma level and above, studying in Malaysia ☐ Please tick here
and still studying, please tick accordingly, if your child is
☐ Degree level and above, studying outside Malaysia disabled
Note: Please attach additional form if you have more than four (4) children
EMERGENCY CONTACT
Name NOOR HAKIMAH BT MOHD NOOR Relationship WIFE
Address PT 15609 JLN LAPANGAN TERBANG,KG KOLAM Contact No. 013-9639160
24300 KERTEH TRG
I , declared that the above information is true and complete as at
Signature: &

027-000-CPF-915 (023746) HRF-0247 Supplementary Page 1

Rev 1 (1-Aug-09)
 EMPLOYEE ANNUAL UPDATE FORM

027-000-CPF-915 (023746) HRF-0247 Supplementary Page 2

Rev 1 (1-Aug-09)